MEDICARE: EMMANUEL VENTURES LIMITED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	RTP.022607100-03	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2136201	OTHER		PK

General Provider Information

NPI Number	:	1053667204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL VENTURES LIMITED LLC

Provider Business Mailing Address
First Line	:	4127 E 131ST ST
Second Line	:	MILES SUPERMARKET
City	:	CLEVELAND
State	:	OH
Zip	:	44105-5563
Country	:	US
Telephone Number	:	216-691-2369
Fax Number	:	216-691-3119

Provider Business Practice Location Address
First Line	:	4127 E 131ST ST
Second Line	:	MILES SUPERMARKET
City	:	CLEVELAND
State	:	OH
Zip	:	44105-5563
Country	:	US
Telephone Number	:	216-691-2369
Fax Number	:	216-691-3119

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	OPEYEMI ADEWESO
Credential	:	RPH
Telephone Number	:	216-691-2369

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	03/30/2017

Similar Medicare Providers

1396558599 — ROSHAWN K SAMPLE
Practice Location Address:

4127 E 131ST ST STE 200
CLEVELAND, OH
44105-5563

Practice Phone: 216-410-5342
Practice Fax:

1598411365 — LAURA MARIE ROSA
Practice Location Address:

12675 BROCKWAY DR
CLEVELAND, OH
44125-5563

Practice Phone: 216-394-1214
Practice Fax:

1528774148 — MICHAEL DEAIR COMBS
Practice Location Address:

5563 HAUSERMAN RD
CLEVELAND, OH
44130-1268

Practice Phone: 216-253-0694
Practice Fax:

1043142110 — RENEWED MINDS TREATMENT CENTER
Practice Location Address:

13205 BEACHWOOD AVE
CLEVELAND, OH
44105-6413

Practice Phone: 216-408-5218
Practice Fax:

1588596571 — VANITA LATRESE HALL
Practice Location Address:

13818 GLENDALE AVE
CLEVELAND, OH
44105-4669

Practice Phone: 216-322-2518
Practice Fax:

1689677809 — DR. IDYA PRAVEEN KUMAR MD
Practice Location Address:

13301 MILES AVE
CLEVELAND, OH
44105-5521

Practice Phone: 216-751-3100
Practice Fax: 216-751-2480

Directions to “EMMANUEL VENTURES LIMITED LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.